Introduction:
Human beings are complex creatures, that are constantly changing and evolving, for better or for worse. There are several aspects of a human’s life, which shape and define their identity in society. Renowned psychologist, Dr. Revel Miller, has put forth his theory of the ‘Life Wheel’, which “encompasses 7 human attributes: 1) Self Aspect, 2) Behavioral Aspect, 3) Social Aspect, 4) Physical Aspect, 5) Emotional Aspect, 6) Mental Aspect and 7) Spiritual Aspect.”[1] Various combinations of these aspects, in differing quantities, are what shape an individual’s identity. Probably the most important aspect out of these, in my opinion, is the mental aspect of a person. I feel that it is the most important, as it can define a person’s character on its own, but can also affect and help to define the other aspects of the individual. Thus, in my opinion, ensuring a healthy mental aspect of a person can subsequently lead to an improvement in all the other life aspects as well.
While mental health is one of the most crucial aspects of an individual’s life, it is also the aspect that is the most susceptible to change. The mental health of any person can be affected easily by certain events or circumstances, thus increasing the need to maintain the proper and steady functioning of the mental functions. Mental illnesses are defined as “health conditions involving changes in emotion, thinking, or behavior.”[2] They are usually a result of external factors such as trauma, abuse, loss, and several others. However, there are also genetic mental illnesses which can be inherited, resulting in a higher probability of mental illnesses being present in people whose blood relatives have mental illnesses. Mental illnesses can vary in the degree to which they affect the person, ranging from serious issues like severe major depression, severe bipolar disorder, and schizophrenia, to relatively less severe illnesses such as anxiety, obsessive-compulsive disorder (OCD) and depression.
Mental illnesses were initially not taken as seriously as necessary. People generally didn’t consider them as serious threats, and often mocked or judged people who were affected by these illnesses. Even in contemporary times, we can see people with mental illnesses being judged or mocked, showing that this mentality has not yet been eliminated. However, while traces of this mentality still exist, society has come a long way since then and is more accepting of mental illnesses now. Many people are more open and more willing to speak about mental illnesses and their experience with it. Additionally, society has also made many changes to be more inclusive in this regard. One big change, which has greatly helped in the acceptance of mental illnesses, is the inclusion of mental illness in medical insurance.
Mental Healthcare Situation in India
Much like most countries of the world, India too was a country where mental health was not given too much importance in ancient times. In colonial and pre-colonial India, the only focus given to mental health was the building of mental asylums. This was driven by a belief that sending people with mental illnesses to mental asylums, and isolating them from other people, was the only effective way to treat their illnesses. The rule of the British in India did not help matters in this regard, as the British did not do anything either to deviate from this unfounded belief. Instead, the British promoted this belief by building more mental asylums across the country, making it more accessible to a larger number of people. Many British organizations, universities, and individuals helped in the funding and development of these mental asylums, thus further contributing to the belief that mental asylums were the only effective treatment method for mental illnesses.
However, this situation began to change after Indian independence in 1947, ushering in a new era for mental healthcare in India. After Independence, “The government of India focused upon the creation of GHPUs rather than building more mental hospitals.”[3] General Hospital Psychiatric Units (GHPUs) are crucial aspects of providing mental healthcare to people in India. In addition to this, they “are also the main training centers for providing postgraduate training in psychiatry and allied disciplines.”[4] This was a better approach to tackling mental healthcare, as it didn’t simply aim to isolate and treat people with mental illnesses, but rather focused on the cause of such problems, spread this knowledge to aspiring doctors and psychiatrists, and aimed to tackle the root of the issue rather than provide a single-tracked and seemingly superficial solution to the problem.
In addition to GHPUs, the government also made several other adjustments towards improving mental healthcare in the country. Firstly, it established several institutions that educated aspiring doctors, psychiatrists, and medical professionals. Secondly, it initiated several specialized services in mental health hospitals, such as child and adolescent services. Furthermore, “Geriatric, epileptic and neuropsychiatric services were added to complete the range of comprehensive OPDs.”[5] This was a big step in improving mental healthcare since it expanded the range of service it offered with respect to mental illnesses, thus subsequently expanding the number of people it could provide services to. Lastly, it also provided alternate accommodation to patients of the mental healthcare hospitals, who had recovered but were unable to return home to their families.
One of the most substantial developments in mental healthcare, however, happened only during the 2000s. It was the inclusion of mental illnesses under medical insurance. This was probably one of the most impactful decisions in the field of mental healthcare. This was according to the Mental Healthcare Act, 2017. Section 21(4) of the Act states:
“(4) Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for the treatment of physical illness”[6]
This is being regulated by the Insurance Regulatory and Development Authority of India (IRDAI), which has directed insurers to provide insurance accordingly for the treatment of mental illnesses. However, there have been reports of insurance firms violating this section of the Act, which has led to the filing of a PIL by advocate Gaurav Kumar Bansal. There is a renewed focus on the topic of mental health and illnesses after the actor Sushant Singh Rajput’s recent suicide.
Conclusion
In conclusion, I feel that the inclusion of mental illnesses in medical insurance was not completely a beneficial move by the IRDAI. This move does have several advantages, however. Firstly, it provides treatment of such illnesses at much lower costs, reducing the burden on patients and their families, especially those who are unable to pay a lot of money for such treatments and medications. Secondly, covering mental illnesses under the same umbrella as any other medical illness provides a sense of inclusiveness which gives a sense of confidence to people who are afraid to speak out about their mental illnesses.
On the other hand, it has many disadvantages as well. Firstly, while some therapists and psychiatrists accept insurance coverage, it is difficult to find such therapists. This is due to a poor relationship between therapists and insurance companies. Secondly, a mental illness diagnosis is required for such treatments, which is close to impossible in certain illnesses that are not diagnosable, such as OCD, Bipolar disorder, etc. Thirdly, a lot of confidentiality which is present in sessions with a therapist is lost in this process. This is due to the fact that the patients’ details and information have to be recorded and filed on their medical record, for insurance coverage to take effect. Lastly, while insurance can cover such treatments, it is only possible for a limited number of therapy sessions, which may not be sufficient for the desired or required treatment. Furthermore, insurance may not cover the specialized treatment of certain illnesses that fall within special areas.
Instead of this, I feel that the government could have acted slightly differently to reduce such a large number of demerits. Firstly, it could have established certain individuals or organizations to bridge the gap between therapists and insurance companies. Secondly, it could have ensured the privacy of the individuals while claiming insurance. Lastly, it could have made a diagnosis optional, rather than mandatory, to ensure insurance to all individuals. I hope that the move made by the IRDAI turns out to be more beneficial than disadvantageous, and will help in the promoting and spreading awareness about the overall importance of mental health.
[1] Miller, R. (2014). The Life Wheel: 7 Aspects of Who You Are. Retrieved from http://www.drrevelmiller.com/wp-content/uploads/2013/08/The-Life-Wheel-Article-1-14.pdf
[2] Parekh, R. (2018, August). What is Mental Illness? Retrieved from https://www.psychiatry.org/patients-families/what-is-mental-illness
[3] Nizamie, S. H., & Goyal, N. (2010, January). History of psychiatry in India. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146221/
[4] Chadda, R. K., & Sood, M. (2018, February). General hospital psychiatry in India: History, scope, and future. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836348/
[5] Nizamie, S. H., & Goyal, N. (2010, January). History of psychiatry in India. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146221/
[6] Mental Healthcare Act, 2017
0 Comments